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Understand Quarantine and Isolation

People can be infected with dangerous diseases in a number of ways. Some germs, like those causing malaria, are passed to humans by animals. Other germs, like those that cause botulism, are carried to people by contaminated food or water. Still others, like the ones causing measles, are passed directly from person to person. These diseases are called “contagious”.

Contagious diseases that pose a health risk to people have always existed. While the spread of many of these diseases has been controlled through vaccination and other public health efforts, avian influenza (“bird flu”) and terrorist acts worldwide have raised concerns about the possibility of a disease risk. That makes it important for people to understand what can and would be done to protect the public from the spread of dangerous contagious diseases.

The CDC applies the term “quarantine” to more than just people. It also refers to any situation in which a building, conveyance, cargo, or animal might be thought to have been exposed to a dangerous contagious disease agent and is closed off or kept apart from others to prevent disease spread.

The Centers for Disease Control and Prevention (CDC) is the U.S. government agency responsible for identifying, tracking, and controlling the spread of disease. With the help of the CDC, state and local health departments have created emergency preparedness and response plans. In addition to early detection, rapid diagnosis, and treatment with antibiotics or antivirals, these plans use two main traditional strategies —quarantine and isolation— to contain the spread of illness. These are common health care practices to control the spread of a contagious disease by limiting people’s exposure to it.

The difference between quarantine and isolation can be summed up like this:

Isolation applies to persons who are known to be ill with a contagious disease.

Quarantine applies to those who have been exposed to a contagious disease but who may or may not become ill.

Definitions

Infectious disease: a disease caused by a microorganism and therefore potentially infinitely transferable to new individuals. May or may not be communicable. Example of non communicable is disease caused by toxins from food poisoning or infection caused by toxins in the environment, such as tetanus.

Communicable disease: an infectious disease that is contagious and which can be transmitted from one source to another by infectious bacteria or viral organisms.

Contagious disease: a very communicable disease capable of spreading rapidly from one person to another by contact or close proximity.

Understand Quarantine and Isolation: Questions & Answers

Questions & Answers

When someone is known to be ill with a contagious disease, they are placed in isolation and receive special care, with precautions taken to protect uninfected people from exposure to the disease.

When someone has been exposed to a contagious disease and it is not yet known if they have caught it, they may be quarantined or separated from others who have not been exposed to the disease. For example, they may be asked to remain at home to prevent further potential spread of the illness. They also receive special care and observation for any early signs of the illness.

How long can quarantine and isolation last? What is done to help the people who experience isolation or quarantine?

The list of diseases for which quarantine or isolation is authorized is specified in an Executive Order of the President. This list currently includes cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named), Severe Acute Respiratory Syndrome (SARS), and influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic.

Isolation

Isolation would last for the period of communicability of the illness, which varies by disease and the availability of specific treatment. Usually it occurs at a hospital or other health care facility or in the person’s home. Typically, the ill person will have his or her own room and those who care for him or her will wear protective clothing and take other precautions, depending on the level of personal protection needed for the specific illness.

In most cases, isolation is voluntary; however, federal, state and local governments have the authority to require isolation of sick people to protect the public.

Quarantine

Modern quarantine lasts only as long as necessary to protect the public by (1) providing public health care (such as immunization or drug treatment, as required) and (2) ensuring that quarantined persons do not infect others if they have been exposed to a contagious disease.

Modern quarantine is more likely to involve limited numbers of exposed persons in small areas than to involve large numbers of persons in whole neighborhoods or cities.

Quarantined individuals will be sheltered, fed, and cared for at home, in a designated emergency facility, or in a specialized hospital, depending on the disease and the available resources. They will also be among the first to receive all available medical interventions to prevent and control disease, including:

Vaccination.

Antibiotics.

Early and rapid diagnostic testing and symptom monitoring.

Early treatment if symptoms appear.

The duration and scope of quarantine measures would vary, depending on their purpose and what is known about the incubation period (how long it takes for symptoms to develop after exposure) of the disease-causing agent.

Examples

A few hours for assessment. Passengers on airplanes, trains or boats believed to be infected with or exposed to a dangerous contagious disease might be delayed for a few hours while health authorities determine the risk they pose to public health. Some passengers may be asked to provide contact information and then released while others who are ill are transported to where they can receive medical attention. There have been a few instances where state and local public health authorities have imposed a brief quarantine at a public gathering, such as a shelter, while investigating if one or more people may be ill.

Enough time to provide preventive treatment or other intervention. If public health authorities determine that a passenger or passengers on airplanes, trains or boats are sick with a dangerous contagious disease, the other passengers may be quarantined in a designated facility where they may receive preventive treatment and have their health monitored.

For the duration of the incubation period. If public health officials determine that one or more passenger on airplanes, trains or boats are infected with a contagious disease and that passengers sitting nearby may have had close contact with the infected passenger(s), those at risk might be quarantined in a designated facility, observed for signs of illness and cared for under isolation conditions if they become ill.

When would quarantine and isolation be used and by whom?

If people in a certain area were potentially exposed to a contagious disease, this is what would happen: State and local health authorities would let people know that they may have been exposed and would direct them to get medical attention, undergo diagnostic tests, and stay at home, limiting their contact with people who have not been exposed to the disease. Only rarely would federal, state, or local health authorities issue an “order” for quarantine and isolation.

However, both quarantine and isolation may be compelled on a mandatory basis through legal authority as well as conducted on a voluntary basis.

States have the authority to declare and enforce quarantine and isolation within their borders. This authority varies widely, depending on state laws. It derives from the authority of state governments granted by the U.S. Constitution to enact laws and promote regulations to safeguard the health and welfare of people within state borders.

Further, at the national level, the CDC may detain, medically examine or conditionally release persons suspected of having certain contagious diseases. This authority applies to individuals arriving from foreign countries, including Canada and Mexico, on airplanes, trains, automobiles, boats or by foot. It also applies to individuals traveling from one state to another or in the event of “inadequate local control.”

The CDC regularly uses its authority to monitor passengers arriving in the United States for contagious diseases. In modern times, most quarantine measures have been imposed on a small scale, typically involving small numbers of travelers (airline or cruise ship passengers) who have curable diseases, such as infectious tuberculosis or cholera. No instances of large-scale quarantine have occurred in the U.S. since the “Spanish Flu” pandemic of 1918-1919.

Based on years of experience working with state and local partners, the CDC anticipates that the need to use its federal authority to involuntarily quarantine a person would occur only in rare situations—for example, if a person posed a threat to public health and refused to cooperate with a voluntary request.

Definitions

Infectious disease: a disease caused by a microorganism and therefore potentially infinitely transferable to new individuals. May or may not be communicable. Example of non communicable is disease caused by toxins from food poisoning or infection caused by toxins in the environment, such as tetanus.

Communicable disease: an infectious disease that is contagious and which can be transmitted from one source to another by infectious bacteria or viral organisms.

Contagious disease: a very communicable disease capable of spreading rapidly from one person to another by contact or close proximity.

White House Pushes Back on State Ebola Quarantines

By

COLLEEN MCCAIN NELSON,

MELANIE GRAYCE WEST and

BETSY MCKAY

The White House pushed back against the governors of New York, New Jersey, Illinois and other states that instituted procedures to forcibly quarantine medical workers returning from West Africa, deepening an emotional debate brought on by recent Ebola cases in the U.S.

A senior administration official said Sunday that new federal guidelines under development would protect Americans from imported cases of the disease but not interfere with the flow of U.S. health workers to and from West Africa to fight the epidemic there.

“We have let the governors of New York, New Jersey and other states know that we have concerns with the unintended consequences… [that quarantine] policies not grounded in science may have on efforts to combat Ebola at its source,” the official said.

Betsy McKay joins the News Hub with the latest on the spread of the Ebola virus and efforts to contain it in the U.S. Photo: University of Texas at Arlington/AP.

It wasn’t clear what action the Obama administration could take to end the quarantines.

New York Gov. Andrew Cuomo on Sunday night gave the first new details about how his state’s quarantine would work, noting that individuals would be allowed to stay in their homes for 21 days. State and local health-care workers would check on quarantined people twice a day to monitor for Ebola symptoms. Those with symptoms would be taken to a hospital. People whose jobs won’t compensate them during their quarantine would be paid by the state.

Travelers who have had no direct contact with Ebola patients wouldn’t be subject to confinement at home, but they would be consulted twice-daily by health officials over the three-week period.

New York officials said the new protocols still went further than those recommended by the federal government.

“My personal practice is to err on the side of caution,” said Mr. Cuomo. Asked if he got White House pressure to shape the policy, Mr. Cuomo said: “I have had none.”

New Jersey state officials said late Sunday night that they wouldn’t change their protocols, which allowed for home quarantine. A New Jersey resident who has no symptoms but has come into contact with someone with Ebola would be quarantined at home. Non-residents would be transported to their homes if feasible, or quarantined in New Jersey if not.

Ms. Hickox, who lives in Maine, has retained lawyers to challenge her quarantine. One of those lawyers, Norman Siegel, a prominent civil rights attorney, said the quarantine policy infringed on her constitutional rights.

New Jersey Gov. Chris Christie held firm on his decision to quarantine returning health-care workers. “I absolutely have no second thoughts about it,” he said on Fox News.

Mr. Cuomo’s announcement on Sunday was made with New York Mayor Bill de Blasio , who had criticized how Ms. Hickox was treated. “State governments have the right to make decisions. But this hero coming back from the front, having done the right thing, was treated with disrespect,” Mr. de Blasio told reporters.

Mr. Christie said Saturday that “I’m sorry if in any way she was inconvenienced, but inconvenience that could occur from having folks that are symptomatic and ill out amongst the public is a much, much greater concern of mine. So certainly nothing was done intentionally to try to inconvenience her or try to make her uncomfortable.”

Although Mr. Cuomo’s policy appears different from New Jersey’s handling of a quarantine case, the White House declined to comment on the New York measures beyond reiterating the principles guiding its own decision-making.

Ebola has killed nearly 5,000 people in West Africa. Nine people have been treated for the virus in the U.S., four of whom either became ill or were infected here. One died.

President Barack Obama convened a meeting of top public health and national security advisers on Sunday to discuss the issue.

Federal, state and local officials are grappling with ways to quell anxiety and protect the public. The different approaches they are taking reflect the layered public health system in the U.S. State and local authorities hold most quarantine powers, while the federal government’s power is more limited, according to legal experts.

The federal government technically could find an argument for challenging state decisions to impose quarantines, said Polly Price, professor at Emory University School of Law. “I could see an argument that there are interstate ramifications,” she said, such as economic disruption. But she said she thought it unlikely, given the political environment and public anxiety over Ebola.

In most cases, the federal government can’t override state quarantines. The Centers for Disease Control and Prevention has powers at ports of entry to the U.S., and can quarantine people who are traveling between states and have infectious diseases such as tuberculosis. Ebola, which can’t be spread through the air, isn’t considered as infectious.

ENLARGE

New York Governor Andrew Cuomo, left, and New Jersey Governor Chris Christie announced a mandatory quarantine for “high risk” people returning to the U.S. through airports in New York and New Jersey. ASSOCIATED PRESS

Craig Spencer, a New York doctor diagnosed Thursday with Ebola after his return from West Africa, appeared to have played a part in the quarantine moves by New Jersey and New York. He was reported in serious but stable condition Sunday at Bellevue Hospital Center in Manhattan.

The Christie administration believes it would win any legal challenge because state law is clear on the government’s ability to quarantine people in public-health emergencies, said a New Jersey state official familiar with the new policy.

During a campaign stop in Florida Sunday, Mr. Christie said that no federal officials had reached out to him about revising the mandatory quarantine.

Christie administration officials knew that public-health experts would disagree with their decision but decided they wanted a broad, tough policy that would calm people’s fears, a Christie official said.

Mr. Cuomo said last week that he consulted with the Centers for Disease Control and Prevention before launching the mandatory-quarantine policy, but Christie administration officials didn’t, a Christie spokesman said.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, said Sunday that the administration is considering a risk-based monitoring system that would elevate the required supervision of health-care workers returning from West African nations.

But he said the protocols would stop short of a mandatory, 21-day isolation of health-care workers that several states have imposed, which risks deterring volunteers heading to Africa to fight the disease.

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“You fashion what you do with them according to the risk,” Dr. Fauci said Sunday morning on NBC. “One of the ways you can mitigate against this issue is by…different types of monitoring.”

Supervision would ratchet up from passive monitoring—individuals regularly taking their temperatures—to “direct active” monitoring, where those who are deemed high-risk are checked by medical workers, he said on NBC.

Scientists say that people who aren’t showing symptoms of Ebola don’t transmit the disease, and Dr. Fauci said other steps besides a mandatory quarantine could ensure public safety. Telling health-care workers that upon returning from West Africa “you still have 21 days out of your life where you can’t move, I think, will have unintended negative consequences,” he said.

Lawrence Gostin, a Georgetown University professor who leads the O’Neill Institute for National and Global Health Law, and is offering help to Ms. Hickox, said she has two main ways to contest her quarantine. The policy in New Jersey applies to a class of people and there “was no individualized assessment of her individual risk,” he said.

The second possible avenue is to argue she wasn’t quarantined in a humane health environment.

“Because this is not a prison sentence, the person has not been convicted. It’s civil and so you’re not supposed to punish them,” said Mr. Gostin.

Mr. Gostin said this was the first time in his memory where such a quarantine was implemented.

But Michael C. Dorf, a professor at Cornell University Law School, said there may not be a sound legal case to challenge a quarantine. The state laws used to implement mandatory quarantines in New York, New Jersey and Illinois are clear and “there is no serious doubt about the affirmative power of either the states and the federal government to quarantine,” Mr. Dorf said

Army major general, troops quarantined after Ebola aid trip

By Barbara Starr,

Army Major General Darryl A. Williams, commander of U.S. Army Africa, and approximately 10 other personnel are now in “controlled monitoring” in Italy after returning there from West Africa over the weekend, according to multiple U.S. military officials.

The American personnel are effectively under quarantine, but Pentagon officials declined to use that terminology.

Williams’ plane was met on the ground by Italian authorities “in full CDC gear,” the official said, referring to the type of protective equipment worn by U.S. health care workers.

There is no indication at this time any of the team have symptoms of Ebola.

They will be monitored for 21 days at a “separate location” at the U.S. military installation at Vicenza Italy, according to U.S. military officials. Senior Pentagon officials say it is not a “quarantine,” but rather “controlled monitoring.” However, the troops are being housed in an access controlled location on base, and are not allowed to go home for the 21 day period while they undergo twice daily temperature checks.

It is not clear yet if they will be allowed visits from family members.

Williams and his team have been in West Africa for 30 days, to set up the initial U.S. military assistance there and have traveled extensively around Liberia. The team was in treatment and testing areas during their travels.

Speaking to reporters two weeks ago while he was still overseas in Liberia, Williams spoke of the extensive monitoring that he was given.

U.S. troops join Ebola fight

“We measure, while we’re here — twice a day, are monitoring as required by the recent guidance that was put out while we’re here in Liberia. I — yesterday, I had my temperature taken, I think, eight times, before I got on and off aircraft, before I went in and out of the embassy, before I went out of my place where I’m staying,” William said during the October 16 press conference.

“As long as you exercise basic sanitation and cleanliness sort of protocols using the chlorine wash on your hands and your feet, get your temperature taken, limiting the exposure, the — no handshaking, those sorts of protocols, I think the risk is relatively low.”

Officials could not explain why the group was being put under into controlled monitoring, which is counter to the Pentagon policy. The current DOD policy on monitoring returning troops says “as long as individuals remain asymptomatic, they may return to work and routine daily activities with family members.”

White House Press Secretary Josh Earnest said Monday that the Defense Department “has not issued a policy related to their workers that have spent time in West Africa.”

“I know that there was this decision that was made by one commanding officer in the Department of Defense, but it does not reflect a department-wide policy that I understand is still under development,” Earnest said.

The Pentagon has, though, published plans that detail how it will handle troops who are deployed to the region — including potential quarantines.

Jessica L. Wright, the undersecretary of Defense for personnel and readiness, issued an Oct. 10 memo that said troops who have faced an elevated risk of exposure to Ebola will be quarantined for 21 days — and that those who haven’t faced any known exposure will be monitored for three weeks.

Wright’s memo also lays out the Pentagon’s plans to train troops before they’re sent to West Africa and to monitor them during their deployment to the epicenter of the Ebola outbreak.

Pressed again during his briefing Monday, Earnest said it’s up to the Defense Department to announce its policies for troops that return from the region.

“We are seeing this administration put in place the policies that we believe are necessary to protect the American people and to protect the American troops,” he said. “And we’re going to let science drive that process. And as soon as we have a policy to announce on this, we’ll let you know.”